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Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies
OBJECTIVES: We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT). METHODS: Several databases were searched in May 2021 for RCTs assessing the e...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634001/ https://www.ncbi.nlm.nih.gov/pubmed/34900334 http://dx.doi.org/10.1136/bmjsem-2021-001110 |
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author | Challoumas, Dimitris Pedret, Carles Biddle, Mairiosa Ng, Nigel Yong Boon Kirwan, Paul Cooper, Blair Nicholas, Patrick Wilson, Scott Clifford, Chris Millar, Neal L |
author_facet | Challoumas, Dimitris Pedret, Carles Biddle, Mairiosa Ng, Nigel Yong Boon Kirwan, Paul Cooper, Blair Nicholas, Patrick Wilson, Scott Clifford, Chris Millar, Neal L |
author_sort | Challoumas, Dimitris |
collection | PubMed |
description | OBJECTIVES: We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT). METHODS: Several databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools. RESULTS: A total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence). CONCLUSIONS: Promising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy. |
format | Online Article Text |
id | pubmed-8634001 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-86340012021-12-10 Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies Challoumas, Dimitris Pedret, Carles Biddle, Mairiosa Ng, Nigel Yong Boon Kirwan, Paul Cooper, Blair Nicholas, Patrick Wilson, Scott Clifford, Chris Millar, Neal L BMJ Open Sport Exerc Med Review OBJECTIVES: We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT). METHODS: Several databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools. RESULTS: A total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence). CONCLUSIONS: Promising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy. BMJ Publishing Group 2021-11-29 /pmc/articles/PMC8634001/ /pubmed/34900334 http://dx.doi.org/10.1136/bmjsem-2021-001110 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Review Challoumas, Dimitris Pedret, Carles Biddle, Mairiosa Ng, Nigel Yong Boon Kirwan, Paul Cooper, Blair Nicholas, Patrick Wilson, Scott Clifford, Chris Millar, Neal L Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
title | Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
title_full | Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
title_fullStr | Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
title_full_unstemmed | Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
title_short | Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
title_sort | management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634001/ https://www.ncbi.nlm.nih.gov/pubmed/34900334 http://dx.doi.org/10.1136/bmjsem-2021-001110 |
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